Ivan Gomez, LPC, NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

178018438 Issued in IL

Practice address

31 W Downer PL Ste 307308
Aurora, IL 60506-5123

Phone

(630) 733-9108

NPI assigned

Oct 18, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Graceful Therapy, PLLC

  • Professional Counselor
  • Oswego, IL
  • NPI 1932687332
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1697587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697587200000",
    "number": "1992587422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1013 LEGRANDE AVE",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605066381",
            "telephone_number": "630-765-4147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 W DOWNER PL STE 307308",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605065123",
            "telephone_number": "630-733-9108"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "113 Main St Ste 203",
            "address_purpose": "LOCATION",
            "city": "Oswego",
            "state": "IL",
            "postal_code": "605432305",
            "country_code": "US",
            "telephone_number": "630-733-9108 x24",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "IVAN",
        "credential": "LPC, NCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-10-18",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178018438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Aller Goldman, PHD, LCPC
• Bryce Goll
• Taylor Marie Goll
• Bianca Gomez
• Cristal Alondra Gomez
• Maricelia Gomez
• Monica Gomez
• Samantha Marie Gomez, RN
• Yobana Gomez
• Alec Gonzales

• Professional Counselor in Aurora, IL
• Providers in Aurora, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.